Forms

FORMS

All new patients are required to complete paperwork before they meet with a provider. If you would like to complete the new patient forms please click on the forms below, print and bring them with you to your first appointment.

OPEN HEALTH CARE CLINIC

Current patients can contact us after hours by calling (225) 655-OHCC (6422)

Notice of Patient PrivacyWe understand that medical information about you and your health is personal and protected health information (PHI). We are committed to protecting your medical information and to share the minimum necessary required to accomplish each purpose. We create a record of care and services you receive through Open Health. We need this record to provide you with quality care and to comply with certain legal requirements. This notice applies to all of your PHI that we have collected while caring for you at our clinic.This Notice of Privacy Practices describes how we are allowed to use and disclose your PHI to carry out treatment, payment or health care operations and for other purposes that are permitted or required by law. This notice also describes your right to access and control your PHI. Download our complete Privacy Notice.